Objective To study the case of 76 patients with choledochoduodenal fistula ( CDF) ,and summarize the experience of mak-ing diagnosis and treatment. Methods From January 1999 to June 2012,76 patients with CDF were treated in our department and then was confirmed by endoscopic retrograde cholangiography ( ERCP) . All patients were classified based on the location of duodenal papilla in rela-tion to the orificium fistulae of CDF. Different therapies were used to certain CDF depending on the diameter of the orificium fistulae of CDF. Of the 76 CDF patients,70 patients (92%) required surgery. Results The fistula of 76 CDF patients have three types,and the formation of this classification was based on the position between the duodenal papilla and the orificium fistulae of CDF. Different therapies referred to cer-tain diameter of CDF,70 patients required surgery and 6 acquired pharmacotherapy. Of the 70 patients needing surgical intervention,clinical outcomes were excellent in 66 patients. Follow-up of these patients for 6 months to 10 years showed they did not suffer from further cholangi-tis. Conclusion The past history of biliary disease,upper abdominal pain,fever,and jaundice may lead to the disease of CDF. ERCP was the primary method for diagnosing this disease,and operative therapy was the primary treatment for most CDF patients.

Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.

Objective To compare the effect of pancreatic duct stent internal versus external drainage in the prevention of postoperative complications after pancreaticoduodenectomy through the method of Meta analysis.Methods PubMed,Embase and the Cochrane Library,were searched for randomized controlled trials (RCTs) concerning pancreatic duct stent in the prevention of postoperative complications after pancreaticoduodenectomy.All these databases were searched from their establishment to March 31,2015.The data was reviewed and extracted by two investigators independently.Then,the Cochrane network RevMan 5.3 software was used for statistic analysis.Results As a result,this meta analysis has got 3 RCTs,including 362 participants.The outcomes in our study design were classified as major and minor one.The former was the outcomes of the major postoperative complications,like postoperative pancreatic fistula and delayed gastric emptying.The minor outcome were postoperative morbidity,mortality and intestinal obstruction.The results of meta analysis were:(1) Postoperative total pancreatic fistula rate (A/B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.59,95％CI:0.36-0.97,P =0.04).(2) Postoperative pancreatic fistula rate (B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.44,95％ CI:0.20-0.97,P =0.04).(3) Postoperative incidence rate of delayed gastric emptying:three studies showed a certain statistic difference between the internal and external drainage groups (OR =0.42,95 ％ CI:0.23-0.79,P =0.007).(4) Post-operative incidence rate of total mortality:three studies showed no certain statistic difference between the internal and external drainage groups (OR =0.81,95 ％ CI:0.23-2.86,P =0.74).(5) As for the postoperative incidence rate of total complications and intestinal obstruction,the heterogeneity was bigger than 50％.So we made an analysis of the cause of heterogeneity.We deduced that it may be caused by the different and complicated perioperative management.Then,we used the random effect model rather than the fixed effect model to make a quantitative analysis.No statistical difference was found eventually in both this two marks.Conclusions By comparing the outcomes in both internal and external drainage groups,we found pancreatic duct stent external drainage could effectively decrease the incidence rate of postoperative pancreatic fistula rate and delayed gastric emptying.But when the limit studies and sample size considered,this conclusion still need to be certificated with more high-quality clinical research.

[Abstract ] Objective Chronic renal disease,a common and frequent disease,is the most cause inducing chronic renal failure. There is an important guiding significance for renal biopsy in the diagnosis,treatment and prognosis of renal disease.The aim of this study was to analyze the characteristics of renal biopsy and the relation between pathological types and clinical presentation in Tibet. Methods Between June 2011 and December 2013 in General Hospital of Tibetan Military Command, Lhasa, percutaneous renal biopsy were per-formed in 107 renal patients.In this study, the gender, age, pathologic entities, and clinical manifestation were analyzed retrospectively. The final diagnosis was made by the clinical manifestation, laboratory examination,and pathologic results. Results The mean age at renal biopsy was 29.8 ±12.2(10~66)years in 47 male cases (43.9%) and 69 female cases (56.1%).This includes 75 Tibetan cases (70.1%), 31 Han cases (28.9%), and Bai cases (1.0%).The primary glomerular disease was 95.3%and the secondary glomerular disease was 4.7%in the total 107 cases.Fourty-four point three percent of the primary glomerular disease were male cases and 100%of secondary glomerular disease were female cases.The main pathological type of the primary glomerular disease was podocyte nephropathy (43.9%), followed by membranous nephropathy (18.7%), IgA nephropathy (11.2%), focal segmental glomerulosclerosis (9.3%) and mesangiocapillary glomerulonephritis (5.6%).The clinical manifestations of 107 cases were classified as syndrome of nephrotic syn-dromn(69.1%),urinary abnormalities(14.9%),isolated macrographic haematuria (3.7%),chronic renal failure(2.8%).Among the nephrotic syndrome,podocyte disease was 63.5%,membranous glomerulopathy was 18.9%,focal segmental glomeruolsclerosis was 8.1%,and membranoproliferative glomerulonephritis was 5.4%. Conclusion The primary glomerulonephritis was the most common glomerular diseases at high altitude area in Tibet.The most frequent type of pri-mary glomerular nephritis was podocyte disease, and the most frequent type of secondary glomerular nephritis was Henoch-Schonlein purpura glomerulonephritis.

Objective To explore the efficacy of partial splenic embolization (PSE) in the treatment of hypersplenism secondary to liver cirrhosis using Meta-analysis.Methods Randomized control studies,cohort studies and case-control studies concerning the efficacy comparison of PSE and splenectomy in the treatment of hypersplenism secondary to liver cirrhosis were searched on PubMed,Embase,Cochrane Library,Wanfang data,CNKI,Cqvip and CBM for Meta-analysis.The cut-off time for searching was July 25,2015.RevMan software designed by Cochrane cooperation network was used for statistical analysis.The major outcomes indexes were preoperative and postoperative levels of platelet,leukocyte and hemoglobin.The secondary outcomes indexes were operative time,intraoperative bleeding and hospital stay.Results A total of 10 studies were selected.Meta-analysis showed the levels of platelet (mean difference [MD]-87.68,95 ％ CI [-125.70,-49.65]),leukocyte (MD-4.03,95％CI [-5.74,-2.33]) and hemoglobin (MD-0.79,95％CI [-1.48,-0.11]) after PSE treatment were higher than those before,and the levels of platelet (MD-128.31,95％CI [-162.59,-94.03]),leukocyte (MD-5.22,95％CI [-6.65,-3.80]) and hemoglobin (MD-1.42,95％CI [-2.66,-0.18]) after splenectomy were higher than those before the operation.The differences of platelet (MD 54.45,95％CI [37.60,71.30]),leukocyte (MD 1.71,95％CI [-0.01,3.42]) and hemoglobin (MD 0.78,95％CI [-0.01,1.56]) between postoperative and preoperative levels for PSE was lower than those for splenectomy.Compared with splenectomy,PSE exhibited less intraoperative bleeding (MD-71.33,95 ％ CI [-78.13,-64.54]),shorter operative time (MD-34.08,95％CI [-34.78,-33.38]) and shorter length of stay (MD-5.59,95％CI [-7.38,-3.79]).Conclusion PSE is a mini-invasive therapy,which can be used to effectively treat hypersplenism secondary to liver cirrhosis.